Significant changes to the way commercial operations raise and product poultry may need to occur to stop the current outbreak of highly pathogenic avian influenza (HPAI).

“Farms were built for efficiency. They were built for production. They weren’t necessarily built for disease control or biosecurity in mind,” Kay Russo, DVM, partner/veterinarian, RSM Consulting, said during the April 12 webinar, “What we know (or don’t) about H5N1 transmission on farms,” hosted by The Pandemic Center, part of the Brown University School of Public Health.

WASHINGTON, April 22, 2025: The Center for Strategic and International Studies (CSIS) announced today that Dr. Elizabeth (Beth) Cameron and Dr. Stephanie Psaki have been appointed as non-resident senior advisers with the CSIS Global Health Policy Center.

Cameron and Psaki are global leaders in health security and biodefense with experience across academia, nonprofit organizations, and in government, including establishing global health security missions at the White House. Dr. Cameron is a professor of the practice and senior advisor to the Pandemic Center at the Brown University School of Public Health. Dr. Psaki recently joined the Brown School of Public Health as a distinguished senior fellow and formerly served as special assistant to the president and the inaugural U.S. coordinator for global health security at the White House.

Of the many mistakes made in the COVID era, none were as glaring as prolonged school closures. The damages go beyond loss of learning, a dire consequence in its own right: Millions of families, both children and parents, still carry the scars of stress, depression, and isolation.

The closures began at a time of understandable panic, but that was only the beginning of the story. On February 25, 2020, Nancy Messonnier, the director of the CDC’s National Center for Immunization and Respiratory Diseases, led a press conference to address the developing coronavirus crisis. Messonnier warned the public that, without vaccines, non-pharmaceutical interventions—things like business closures or social-distancing guidelines—would be the most important tools in the country’s response. “What is appropriate for one community seeing local transmission won’t necessarily be appropriate for a community where no local transmission has occurred,” she said. The school closures that would be implemented the following month—and that endured through the end of the school year in nearly all of the roughly 13,800 school districts in the United States, in regions that had wildly different infection levels—showed this directive was not followed.

Emerging and/or re-emerging infectious diseases (EIDs) in the East Africa region are associated with climate change-induced environmental drivers. There is a need for a comprehensive understanding of these environmental drivers and to adopt an integrated risk analysis (IRA) framework for addressing a combination of the biological, environmental and socioeconomic factors that increase population vulnerabilities to EID risks to inform biological risk mitigation and cross-sectoral decision-making. The aim of this integrative review was to identify knowledge gaps and contribute to a holistic understanding about the environmental drivers of Crimean-Congo haemorrhagic fever virus (CCHFV), Marburg virus (MARV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the East Africa Region to improve IRA processes at the environment-animal-human exposure interface.

THREE PEOPLE HAVE DIED in Texas and more than five hundred have gotten sick in what is shaping up as the largest single measles outbreak in decades. And somehow Robert F. Kennedy Jr. still hasn’t provided a firm, unambiguous endorsement of vaccination, although you could be forgiven for thinking otherwise in light of the publicity around an interview he had with CBS News last week.

The interview aired on Wednesday, after Kennedy had met with the families of two Texas girls who recently died from the disease. The online version carried the headline “RFK Jr. says people should get the measles vaccine,” and if you happened to be on social media at the time (like I was) then some version of it probably popped onto your feeds.

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The blue rubber gloves and N95 masks in a Seattle senior living community used to mark a time of isolation, fear, loss.

Yet on a recent afternoon at Merrill Gardens in Ballard, these medical supplies are more like ornaments of the past, strung across the ceiling as an almost whimsical ode to how far we’ve come.

It’s been five years since the mysterious respiratory virus responsible for an emerging pandemic was identified in Washington state and the U.S., and forced millions of us, including hundreds of Merrill Gardens residents in the Northwest, to shut in, avoid physical contact and distance from one another for months.

Not today. On this particular gray Friday, residents and staffers are celebrating. Along with the PPE garlands, a colorful banner is pinned up in the window: “Heroes Work Here.”

“We didn’t lose a single person during COVID,” general manager Lisa Palm said, speaking just of the Ballard living facility, to a room of cheering residents. All were unmasked.

She raised a glass of Champagne. “Cheers to all that being in the past.”

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Aggressive deportation tactics have terrorized farmworkers at the center of the nation’s bird flu strategy, public health workers say.

Dairy and poultry workers have accounted for most cases of the bird flu in the U.S. — and preventing and detecting cases among them is key to averting a pandemic. But public health specialists say they’re struggling to reach farmworkers because many are terrified to talk with strangers or to leave home.

“People are very scared to go out, even to get groceries,” said Rosa Yanez, an outreach worker at Strangers No Longer, a Detroit-based Catholic organization that supports immigrants and refugees in Michigan with legal and health problems, including the bird flu. “People are worried about losing their kids, or about their kids losing their parents.”

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On Tuesday at a press conference, Health and Human Services Secretary Robert F. Kennedy Jr. said his department's handling of measles cases, including the outbreak in Texas should be a "model for the rest of the world."

Kennedy said this is because cases have exploded more drastically in Europe -- though he didn't offer specifics on what he thinks has worked in the U.S. response.

"I would compare it to what's happening in Europe," he said. "They've had 127,000 cases and 37 deaths. And so what we're doing here in the United States is a model for the rest of the world."

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Health and Human Services Secretary Robert F. Kennedy Jr. seemed to imply in recent days that the measles outbreak in western Texas was slowing down.

In a post on X on Sunday, Kennedy remarked on the second death linked to the outbreak, which occurred in an unvaccinated school-aged child.

About 10 minutes later, Kennedy edited the post to add that the curve has been flattening since early March, when he started sending in reinforcements from the Centers for Disease Control and Prevention -- supplying clinics with vaccines and other medications.

"Since that time, the growth rates for new cases and hospitalizations have flattened," he wrote.

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Slipping vaccination rates in West Texas have led to the state's largest measles outbreak in over 30 years, with more than 500 patients affected as of April 8 and cases spreading to New Mexico and Oklahoma. Last week, an unvaccinated Texas child died from measles, marking the third death tied to the outbreak.

Public health experts say there is a playbook for slowing outbreaks like this one: Identify cases. Isolate patients. Track where they've been and who they may have exposed. Most of all, drive up the vaccination rate.

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Dr. David Fleming spent last week learning of the scope of the cuts at the Centers for Disease Control and Prevention, not through meetings with department officials or emails, but by text messages and news stories. As far as he knows, he said, there is still no official public list of the cuts. "This is unprecedented, both in the scale and scope of destruction of CDC, and unprecedented in the secret manner in which it's been being carried out," said Fleming, a public health professional in the state of Washington and chairman of the Advisory Committee to the Director of the CDC.

Read more at: https://www.macon.com/news/article303598321.html#storylink=cpy

Professor at Brown Univeristy School of Public Health and former CEO of GAVI, the vaccine alliance, Dr Seth Berkley championed equitable access to vaccines and co-founded Covax during the pandemic. In an interview with Sunday Times he watns of the repercussions of abrupt fund cuts
Excerpts:

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As the Trump administration moves to dismantle international public health safeguards, pull funding from local health departments and legitimize health misinformation, some experts now fear that the country is setting the stage for a long-term measles resurgence.

If federal health officials do not change course, large multistate outbreaks like the one that has torn through West Texas, jumping to neighboring states and killing two people, may become the norm.

“We have really opened the door for this virus to come back,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention.

On April 1, the Trump administration began making sweeping changes to the U.S. Department of Health and Human Services (HHS) by firing thousands of staff, some of whom learned of this decision when they arrived at work on Tuesday morning and were not allowed to enter the building. According to HHS, the administration plans to reduce the HHS workforce from 82,000 full-time employees to 62,000. It is also consolidating the current 28 divisions into 15 divisions, and eliminating five of the 10 regional offices in the United States, among other changes.

HHS Secretary Robert F. Kennedy Jr. framed these changes as part of his “Make America Healthy Again” agenda, citing recent declines in life expectancy, while neglecting to mention that those declines were largely due to the COVID-19 pandemic. The Trump administration’s stated goals are to streamline HHS, save taxpayer money, focus more on chronic illness, and make HHS more responsive and efficient. It claims it can make these reforms without impacting critical services. In practice, however, the administration has cut essential funding that was helping states and cities prepare for outbreaks; reassigned leaders who were stopping biological threats in other countries from spreading; undermined the United States’ ability to quickly review and approve treatments and vaccines during an emergency; and disrupted essential work to create vaccines, tests, and treatments for dangerous diseases. These approaches do not make America healthy. They make America less safe.

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Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University's School of Public Health, leads the conversation on complex public health emergencies.

This work represents the views and opinions solely of the author. The Council on Foreign Relations is an independent, nonpartisan membership organization, think tank, and publisher, and takes no institutional positions on matters of policy.

About this episode:
For 25 years, Gavi, the Vaccine Alliance has been a global effort to purchase and distribute lifesaving vaccines to the poorest of countries and help them build up their health systems. Now, it’s the latest chop in a blitz of proposed federal funding cuts to global health. In this episode: an overview of Gavi’s innovative model that buys vaccines for 50% of the world’s children and has prevented around 19 million deaths, and the catastrophic potential if the U.S. withdraws its financial support.

Guest:
Dr. Seth Berkley is the former CEO of Gavi, the Vaccine Alliance. He is a senior advisor to the Pandemic Center and an adjunct professor of the practice in epidemiology at the Brown University School of Public Health. His new book, Fair Doses, will be released next fall.

Host:
Stephanie Desmon, MA, is a former journalist, author, and the director of public relations and communications for the Johns Hopkins Center for Communication Programs, the largest center at the Johns Hopkins Bloomberg School of Public Health.

Egg prices are dropping in the United States, pushing highly pathogenic avian influenza out of the political and economic spotlight. However, the disease won’t likely be cowed by the temporary reprieve, health experts have warned.

“I keep hearing a sort of a hope, a wish, and perhaps a belief ... that this is going to blow over,” Jennifer Nuzzo, the director of the Pandemic Center at Brown University School of Public Health, said at a panel focused on the U.S. experience with H5N1 bird flu. “I’m here to say that it’s not going to blow over somehow, that this is really a long-term situation that we have to deal with.”

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Dallas, Texas – Therissa Grefsrud still remembers the email. The COVID-19 pandemic had been raging for nearly a year, and a woman had reached out to ask about vaccines: Would they cause infertility in her or her future children?

Grefsrud, a nurse specialised in infection prevention, had heard such concerns before. But studies show no link between infertility and vaccination of any kind.

Still, Grefsrud exchanged messages with the woman as she shared her fears. Then she pointed her towards the facts.

“She came to me about a month later and let me know how grateful she was for me making this space without judgement,” Grefsrud said. The woman also shared that she was now vaccinated.

Fast forward four years, and Grefsrud is among the healthcare professionals in Texas confronting a new outbreak: measles.

When Stephanie Psaki, a senior fellow in public health, joined the U.S. Department of Health and Human Services in 2021, she was tasked with helping coordinate the government’s response to the global COVID-19 pandemic.

She then joined the National Security Council at the White House in the Biden-Harris administration where she worked for two and a half years. A scientist and an academic by training, she told The Herald she didn’t expect to move to this policy-focused role.

“I didn’t think that I was going to do this job when I was in undergrad or in grad school,” she said. “It never occurred to me.”

But now, Psaki has returned to academia, bringing her policy experience to Brown.

Leaders at the Centers for Disease Control and Prevention ordered staff this week not to release their experts’ assessment that found the risk of catching measles is high in areas near outbreaks where vaccination rates are lagging, according to internal records reviewed by ProPublica.

In an aborted plan to roll out the news, the agency would have emphasized the importance of vaccinating people against the highly contagious and potentially deadly disease that has spread to 19 states, the records show.

A CDC spokesperson told ProPublica in a written statement that the agency decided against releasing the assessment “because it does not say anything that the public doesn’t already know.” She added that the CDC continues to recommend vaccines as “the best way to protect against measles.”

But what the nation’s top public health agency said next shows a shift in its long-standing messaging about vaccines, a sign that it may be falling in line under Health and Human Services Secretary Robert F. Kennedy Jr., a longtime critic of vaccines:

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The US National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) have begun cancelling billions of dollars in funding for research related to COVID-19.

COVID-19 research funds “were issued for a limited purpose: to ameliorate the effects of the pandemic,” according to an internal NIH document that Nature has obtained and that provides the agency’s staff members with updated guidance on how to terminate these grants. “Now that the pandemic is over, the grant funds are no longer necessary,” the document states. It is not clear how many of these grants will be ended.

What are the biggest threats to the health security of the American people? There are some strong candidates. Avian influenza is spreading in birds, cattle, and 50 mammalian species. Measles cases are surging at home and abroad. COVID-19 is still spreading and could mutate into a more deadly strain. Farther afield, Uganda continues to respond to an Ebola outbreak and Mpox has been seen in 127 countries. But perhaps the biggest threat to America’s health could be self-inflicted. According to a report published yesterday in the New York Times, our leaders intend to end funding for international immunization programs—including the Gavi Alliance I led from 2011 to 2023—that for decades have protected Americans from health threats abroad. These cuts would represent a grave threat to the health, well-being, and livelihoods of every American.

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The United States cutting funding to Gavi, an organisation that provides vaccines to the world's poorest countries, could result in more than a million deaths and will endanger lives everywhere, the group's CEO warned on Thursday.

The news that Washington is planning to end funding for Gavi, first reported in the New York Times, comes as the two-month-old administration of President Donald Trump aggressively slashes foreign aid.

The decision was included in a 281-page spreadsheet that the severely downsized United States Agency for International Development sent to Congress on Monday night.

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The US National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) have begun cancelling billions of dollars in funding on research related to the COVID-19 pandemic.

COVID-19 research funds “were issued for a limited purpose: to ameliorate the effects of the pandemic”, according to an internal NIH document that Nature has obtained and that provides the agency’s staff members with updated guidance on how to terminate these grants. “Now that the pandemic is over, the grant funds are no longer necessary,” the document states. It is not clear how many COVID-19 grants will be terminated.

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A project to track and contain menacing animal viruses across seven countries, from avian influenza in poultry to Lassa virus in rodents, ended with a single email. In late January, Jonathon Gass, an epidemiologist and virologist at Tufts University, was about to leave for Bangladesh to close out an effort to monitor and combat avian influenza, when the emailed letter arrived from the U.S. Agency for International Development (USAID), ordering an immediate halt to work on the $100 million STOP Spillover project. Gass, a co-deputy director of the project, stayed in Massachusetts and started to call staff around the world to tell them to drop everything. One colleague monitoring Lassa virus in Liberia was driving to a field site. “I had to tell him that he needed to turn the car around, come back, and book a plane ticket home,” Gass says.

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The White House is nominating Dr. Susan Monarez, the current acting director of the US Centers for Disease Control and Prevention, to lead the agency, President Donald Trump said Monday.

The move comes weeks after the White House abruptly withdrew its nomination of Dr. Dave Weldon to lead the public health agency.

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After returning home from a trip abroad last week, an infant in Houston was hospitalized with measles.

In Lamoille County, Vermont, this month, a child became sick with measles after returning from foreign travel.

The same thing happened to an adult in Oakland County, Michigan, whose vaccination status was unknown.

Although measles was declared eliminated in the United States in 2000, it still rages on in many parts of the world. With decreasing vaccination rates across the US, experts say, imported cases can have large consequences.

“Each one of those imported cases now is like a match being thrown into a bit of forest,” said Dr. Brian Ward, associate director of the JD MacLean Tropical Disease Center at McGill University. “The susceptible people in our communities now are like that accumulating fuel in a forest.”

Often, these illnesses happen “because a US resident goes outside of the US and is exposed and brings measles back. And I think that’s something that’s been happening for a while, and we’re certainly seeing … an upward trend in the last couple of years,” said Dr. Matthew Ferrari, director of the Center for Infectious Disease Dynamics at Penn State University.

The outbreak spanning Texas, New Mexico and Oklahoma is behind the majority of the more than 400 US measles cases this year, according to a CNN tally, but there have been many reports of travel-related cases throughout the country.

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Without US funding, there has been immediate disruption to controlling the mpox outbreak. Now is the time for global health leaders, philanthropic organisations and other high-income nations to step up and fill the void left by the funding withdrawal.

The viral zoonotic disease mpox (formerly known as monkeypox) has periodically affected African nations since its discovery in 1958.

Historically, it remained confined to specific regions, primarily within central and west Africa. However, the outbreak that began in 2022 marked a significant escalation, with cases spreading beyond usual endemic regions. By mid-2022, the virus had reached multiple continents, prompting the World Health Organization (WHO) to declare a public health emergency of international concern in early May, 2022. Unlike previous outbreaks, the 2022-2023 epidemic saw a significant number of cases in Europe and the Americas.

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Is another COVID already here? A leading researcher shares the latest tracking on bird flu.

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Egg prices have risen 50% since March 2024, the result of an ongoing bird flu crisis that has both producers and consumers grappling for solutions. According to the U.S. Department of Agriculture, 166 million chickens have been infected and killed in the past three years, which means there are fewer egg-laying chickens, reduced supply, and higher prices. Mandatory culling, inadequate government reimbursement, and prevention costs have led to $1.4 billion in losses for the poultry industry, hurting both farmers and everyday Americans. But despite these soaring costs, the U.S. is about to sunset a relatively affordable, very effective tool we have for stopping bird flu — and other deadly viruses.

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Improves learning. Reduces sick days. Prevents disease spread.

Measles is like a fire that spreads incredibly fast. It's one of the most contagious diseases.

And the last thing you'd want to do in a fire scenario is get rid of smoke detectors, says Jennifer Nuzzo, director of Brown University's Pandemic Center. But, she says, that's exactly what's happening now, just as measles cases rise in the U.S. and other countries.

She's talking about the U.S. decision to stop funding the Global Measles and Rubella Laboratory Network.

"It's our surveillance infrastructure. You can think of it like the smoke detectors that tell us where the fires are, so that we know how to respond to it," says Nuzzo. "So this is obviously devastating and it's particularly devastating given how many countries are struggling with measles [outbreaks]."

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Devex sat down with the former head of Gavi to discuss the difficult times ahead as the foreign aid landscape drastically changes; what this could mean for the health of the world's population, and where priorities should lie.

The health of the world’s population exists on shaky grounds amid widespread cuts in foreign aid and the U.S.’s withdrawal from global cooperation.

Berkley served as head of Gavi from 2011 to 2023, and now works in advisory roles for organizations, such as the Serum Institute of India, in areas such as vaccines, and other interventions for diseases impacting low- and middle-income countries.

His tenure at Gavi included a tumultuous period where there was extraordinary need for international solidarity and cooperation: The COVID-19 pandemic. This cooperation was present in some ways as countries banded together to create COVAX, the world’s attempt at vaccine equity — which Berkley led. But in other ways, it fell completely flat, including when wealthy countries hoarded vaccines.

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Dr. Craig Spencer, a Brown University School of Public Health professor, discusses the greater implications of Elon Musk's DOGE cuts in the health sector.

Now is the time to continue the momentum towards achieving African vaccine sovereignty. We must work to both increase the continent’s vaccine manufacturing capacity and then develop strategies to promote their uptake.

Five years to the day after the World Health Organization first referred to Covid-19 as a pandemic, the US National Institutes of Health slashed grant funding for projects that aim to understand vaccine hesitancy and promote vaccine uptake. The Covid-19 pandemic and more recent outbreaks of mpox, Marburg and Ebola underline the importance of regionalised vaccine manufacturing to ensure access to vaccines for people in Africa. Yet, without research to inform strategies to improve trust in vaccines and promote their uptake, the gains in manufacturing will not translate to lives saved.

Defunding research that aims to improve vaccine uptake is another historic mistake in what has become a sad litany of health science reversals by the Trump administration. In January 2025, before the funding cuts were announced, leading vaccine researchers from around the world published an article calling for countries to measure the social and behavioural reasons that people choose to get vaccinated or not and to use this information to design approaches to improve vaccine uptake. Heeding this call is now more important than ever to ensure that the vaccines produced in Africa are taken up by those who can benefit from them – otherwise what is the point?

We must work to both increase African vaccine manufacturing capacity and develop strategies to promote their uptake once they are made. Currently, only 1.1% of Africa’s vaccine supply is produced locally. This overdependence on foreign vaccine supplies leaves African people vulnerable. This challenge is heightened by the inequity in access to foreign supplies, a disparity that became especially evident during the Covid-19 pandemic. While the Covid vaccination campaign was the largest and fastest in history, Africa faced significant challenges in access and distribution. By November 2022, almost two years after high-income countries began vaccinating their citizens, only 25% of the people in Africa had been fully vaccinated against Covid-19.

At the beginning of the pandemic, initiatives such as the Covax facility, a global Covid-19 vaccine procurement mechanism, signalled positive steps towards global solidarity for equitable vaccine access. Although this effort was highly commendable, the reality was very different. Gavin Yamey, the director of Duke University’s Center for Policy Impact in Global Health who was involved in the early discussions about Covax, declared that “rich countries behaved worse than anyone’s worst nightmares”. Wealthy countries were first in line to receive vaccines because they were able to place orders for multiple candidates in their early stages of development. Hoarding of these vaccines led to what World Health Organization (WHO) director-general Tedros Ghebreyesus called “vaccine apartheid”, as booster doses of the Covid-19 vaccine were widespread in high-income countries before people in low-income countries had even received a first dose.

Once vaccines are available on the African continent, how can policymakers be sure that the regulatory process for their approval, technical expertise to run clinical trials, and health workforce to administer vaccines are in place to be able to ensure that vaccines reach those who need them? For example, the response to the current mpox public health emergency of international concern has been plagued by delays in authorisation for the vaccine and limited data on the effectiveness of these vaccines in children.

The ongoing challenges with vaccine access in Africa continue to cause preventable loss of life even though it is well established that early access to vaccines in an outbreak can stop a virus in its tracks. Strengthening vaccine manufacturing capacity on the continent will ensure long-term health security across the continent. Promising efforts are already under way that must be supported and expanded, particularly in light of uncertainties surrounding US funding for global health. As of late 2024, there were five African vaccine suppliers in four countries – South Africa (Aspen Pharmacare and Biovac), Senegal (Institut Pasteur de Dakar), Morocco (Marbio) and Egypt (Vacsera) – with scaled facilities that are close to commercialisation. A further 20 suppliers across the continent are in development or awaiting technology transfer.

In 2021, the African Union announced its goal of supporting the African vaccine manufacturing industry to produce more than 60% of the vaccine doses required on the continent by 2040. The Partnerships for African Vaccine Manufacturing was created under the Africa CDC in 2021 to achieve this goal and was expanded in 2024 to include all health products under a new name, the Platform for Harmonized African Health Products Manufacturing. As of June 2024, there are 25 active vaccine projects across the continent. Initiatives such as the WHO’s mRNA technology transfer hub and those supported by the Coalition for Epidemic Preparedness Innovations (Cepi) also have been working to increase African vaccine manufacturing, and fostering vaccine sovereignty.

In 2024, major African-led initiatives were launched to accelerate African vaccine manufacturing. The African Vaccine Manufacturing Accelerator received a $1.2-billion investment, through reallocated Covid-19 funds from other country’s governments and philanthropies, to expand vaccine manufacturing on the continent, Afreximbank pledged $2-billion in support of African Health Products Manufacturing, and regulatory bodies from seven African countries signed a memorandum of understanding to promote a strong, harmonised regulatory system on the continent.

Countries including Rwanda are also setting a strong example. Leveraging a tremendous amount of preparation and partnerships with the private sector and global public health organisations such as Cepi, just 10 days after the outbreak was declared, Rwanda implemented clinical trials of the Sabin mpox vaccine.

Achieving self-reliance in vaccine production in Africa is possible. In combination with continued efforts to understand and promote vaccine uptake, we need whole-of-government approaches that support the growth of vaccine manufacturing on the continent. The ministries of health and finance must work together to develop strategic approaches for preferential procurement practices of regionally produced vaccines. There needs to be harmonisation of the regulatory bodies on the continent with the WHO’s prequalification process – an approval process required for vaccines to be bought by UN agencies such as Unicef – so that safe and effective vaccines can reach populations in need and at scale.

Now is the time to continue the momentum towards achieving African vaccine sovereignty. These efforts will save lives if people have the confidence and trust to take them. DM

Margaret Dunne is a doctoral candidate in the Department of Epidemiology; Thokozani Liwewe a medical doctor and global health professional working with the Ministry of Health, Malawi, and a Game Changers Fellow; Alice Im is a research assistant; Andrea Uhlig is a research associate; Carly Gasca is a project director; and Wilmot James is a professor and senior adviser – all at the Pandemic Center in Brown University’s School of Public Health, Providence, Rhode Island.

The CDC has historically been the backbone of US public health, delivering essential resources, guidance, and disease surveillance to state and local health departments. However, as the agency faces workforce reductions and funding cuts, public health experts warn about the unsettling future of infectious disease preparedness, response efforts, and access to vital health care programs. The consequences of these changes could be catastrophic, jeopardizing our safeguards against outbreaks and public health crises.

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Rachel Feltman: For Scientific American’s Science Quickly, I’m Rachel Feltman.

This week marks the fifth anniversary of COVID being declared a global pandemic. So much changed about all our lives then that we are still feeling five years later.

As we reflect on this anniversary, our producer Fonda Mwangi took a pulse check on where the U.S. public health system is now and the lessons it’s learned.

Bird flu is sweeping through egg-laying chickens in the United States at an unprecedented rate. So far in 2025, 30 million layers, as they’re known, have been culled, close to the 38 million killed throughout all of last year: Nearly 10 percent of the country’s annual number of egg-layers have been wiped out. But one of the big questions, as egg prices become a potent political football, is this: Are these shocking infection rates and cull tallies to blame for skyrocketing prices? Or is something else going on?

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Masking up. Distance learning. Social distancing. No one could have predicted the profound changes that followed the World Health Organization’s declaration of COVID-19 as a global pandemic five years ago Tuesday.

Dozens of essential care workers and advocates gathered outside the State House to remember Rhode Island’s nearly 4,500 victims of the pandemic and address the ongoing challenges their field still faces.
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When the virus that caused the COVID-19 pandemic first emerged, many scientists thought it would evolve slowly, like other coronaviruses.

But that was one of the first big surprises from the virus dubbed SARS-CoV-2. It evolved like crazy.

"SARS-CoV-2 so far has probably been even faster than influenza virus, which is really remarkable," says Jesse Bloom, who studies viral evolution at the Fred Hutch Cancer Center in Seattle. "I thought it would undergo some evolution, but the speed at which it's undergone that evolution and the ability it's shown to undergo these big evolutionary jumps is really remarkable."

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On Monday, the Director of the Pandemic Center Jennifer Nuzzo presented a lecture titled “Pandemic-Proofing the Future” at a Presidential Faculty Award Lecture. Five years after a state of emergency was declared for COVID-19 by the World Health Organization, Nuzzo discussed ways we can better prepare for future pandemics.

President Christina Paxson P’19 P’MD’20 opened the event and Nuzzo was introduced by Francesca Beaudoin PhD’16, the academic dean of the School of Public Health.

Nuzzo, who is also a professor of epidemiology, opened her lecture by recognizing the devastating “failures” of the American health care system after nationwide shutdowns left cities, such as New York City, desolate.

“I don’t want to imply that New York was wrong to (shutdown),” Nuzzo told The Herald in an interview after the event. “The fact that it had to come to that was a failure.”

Bird flu has been spreading in North America since late 2021, but recently the situation has taken some concerning turns.

In January, the first person in the US died from bird flu. In February, two more people were hospitalized, and officials detected two new spillovers into cows, indicating the virus is here to stay among livestock and farm workers. The price of eggs has also skyrocketed as bird flu moves through egg-laying chickens.

“The past couple of weeks, it’s all been new plot twists in the H5N1 story,” said Meghan Davis, an associate professor of environmental health at the Johns Hopkins Bloomberg School of Public Health.

People who work closely with wild and domesticated animals should take precautions, such as washing their hands, wearing a face mask while handling sick or dead poultry and cleaning their litter, and monitoring symptoms after contact with animals.

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Five Years Later
Sumbul Siddiqui remembers every detail about the morning of March 10, 2020. She remembers feeling anxious as she walked into a Somerville conference room packed with masked-up mayors from around Boston. She remembers grim-looking doctors from Italy appearing on a big screen, describing the horrors of people collapsing and dying from a mysterious respiratory illness.

After that, Siddiqui, then mayor of Cambridge, did what she never imagined she would have to do: She called top city administrators and the school superintendent to begin the process of shutting down every school and municipal building in the state’s fourth-largest city.

“We all left that meeting terrified,” she said. “I remember saying, ‘OK, we have to shut things down. We have to stop the spread. I don’t want people to die.‘”

Five years later, Siddiqui is still torn about the decision. On that same day, Governor Charlie Baker declared a state of emergency in Massachusetts and, within days, suspended in-person learning at public and private schools and banned on-site dining at bars and restaurants across the state.

Knowing what we know now, she wonders, did public officials overreact? Did they adequately consider the trade-offs among competing values, including the devastating costs of closing schools, businesses, and places of worship?

Those questions remain as relevant now as they were in the spring of 2020. As a lethal strain of avian influenza (or H5N1) spreads from birds and mammals to people, the specter of another pandemic looms over the United States. Public health officials and epidemiologists are dissecting the dizzying range of responses to the COVID-19 pandemic — including the stay-at-home orders, school closures, and quarantines — to determine what worked and what didn’t.

A growing number of scientific studies have concluded the measures in the United States did little to slow the rampaging pathogen. What’s more, the stifling of public debate about them eroded trust in public health policy and prevented more effective strategies, according to a number of prominent infectious-disease experts.

While the scientific community is still divided over how effective lockdowns were, those who publicly criticized the measures during the pandemic have gained the political upper hand. Dr. Jay Bhattacharya of Stanford University, who co-authored a manifesto against lockdowns, is President Trump’s nominee to lead the National Institutes of Health, the nation’s largest funder of biomedical research with a $48 billion budget. And Trump’s health secretary, Robert F. Kennedy Jr., has described lockdowns as an attack on the poor and middle class.

“We are long overdue for a reckoning on the lockdowns,” said Stephen Macedo, a political scientist at Princeton University in New Jersey, who co-authored a book due out later this month that calls for a national inquiry into the lockdown measures. “What’s become increasingly clear is that a lot of what we did was irrational and based on fear, and we didn’t think through the profound costs.”

Defenders of lockdown policies have argued that stay-at-home orders were among the few levers in the government’s pandemic toolkit, particularly before mass testing and vaccines were available. And a chorus of studies have found that, early in the pandemic, measures such as shutting schools and banning large gatherings did help suppress the virus’ spread in the short term — saving thousands of lives and preventing many hospitals from being overwhelmed.

“This revisionist history that says, `We could have done without the lockdowns,’ is dangerous,” said Dr. Nahid Bhadelia, founding director of Boston University’s Center on Emerging Infectious Diseases. “You would have faced even more deaths and even more hospitalizations in a shorter period of time, which would have debilitated our health care system.”

But while the impact of lockdown policies is still being studied, new research paints a troubling picture of the immense collateral damage inflicted by them.

The measures increased poverty and wealth disparities, spurred a dramatic rise in adolescent anxiety and depression, contributed to a surge in fatal drug overdoses, and led to devastating learning losses in schoolchildren, who have yet to recover, according to scientific studies. As of last spring, the average American student remained half a grade behind pre-pandemic levels in both math and reading, according to a recent report card on pandemic learning loss.

What’s more, months of unrelenting seclusion caused many people to sever social connections, with lasting consequences to mental and physical health. Both volunteering at nonprofits and church attendance, two measures of social engagement, declined and have not recovered to pre-pandemic levels. In 2023, the nation’s surgeon general warned of an "epidemic of loneliness and isolation" — brought on, in part, by lockdown measures that isolated people.

And that’s not counting the other costs in lost livelihoods, shuttered businesses, and the anguish of seeing relatives die alone without being able to say goodbye.

“The lockdowns were never really effective, and the confusion around them sowed a great deal of public distrust in government,” said Michael Osterholm, an infectious disease expert at the University of Minnesota.

On average, states with Democratic governors had stay-at-home orders that were nearly three times longer than those in red states. Yet many so-called blue states — including California, New York, and New Mexico — had among the highest COVID-19 death rates, measured as a share of their population. And some red states, including Idaho and Utah, had among the lowest, national health data shows, according to an analysis by Macedo and a Princeton colleague, Frances Lee..

Those critical of lockdowns point to sobering data showing that, despite widespread school and business closures, the United States had among the worst mortality rates in the developed world during the pandemic.

To be sure, a wide range of factors — including vaccination rates, population density, air pollution, and the age of the population — can influence differences in COVID-19 mortality rates, researchers note.

Infectious disease experts who are critical of lockdowns point to alternative approaches that would protect public health with less pain should another pandemic arise. These include more stringent testing of workers in nursing homes, more generous sick leave policies for workers, and efforts to expand home care and food deliveries for older people most vulnerable to the virus.

“You couldn’t witness the mass deaths in New York City and Italy and not think that something had to be done,”said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health. “But tools like shutdowns and school closures are sledgehammers and shouldn’t be part of our toolbox.”

The other problem with lockdowns, say many scientists, is they cannot be sustained indefinitely. And once they are lifted, people start interacting again and infections can spread rapidly. For instance, China’s abrupt decision in December 2022 to end its zero-COVID policy, which included stringent quarantines and lockdowns, led to a massive surge in hospitalizations and deaths in the following two months, according to a 2023 study in the medical journal JAMA.

Osterholm at the University of Minnesota has long recommended what he calls the “snow day approach.” When infections surge, or hospital bed capacity falls to unsafe levels, officials could announce temporary school closures and encourage people to stay home. Then, when the virus subsides, after a few days or weeks, the restrictions would be lifted, he said. People would be more willing to comply, knowing the closures are temporary, he argued.

“In defense of public health [officials], they were trying to manage so many unknowns,” Osterholm said. “It was like trying to perform brain surgery while you’re jumping out of a plane and the parachute wasn’t opening.”

Public officials should also communicate more clearly about the uncertain benefits of any measure during a pandemic, particularly when so much is unknown, public health experts said.

Indeed, in October 2019, the World Health Organization analyzed a range of responses to past pandemics, including the 1918 “Spanish flu,” and recommended against forced quarantines of individuals or populations, saying there was “no obvious rationale” for such measures and they were impractical to implement.

“From the beginning, the evidence to support lockdown policies was very, very poor, and there was a large sentiment within the scientific community that the collateral damage far outweighed the benefits,” Macedo, of Princeton, said.

In the bitterly polarizing climate of 2020, some scientists who spoke out against lockdowns in favor of less-restrictive measures faced a harsh backlash. Some even received death threats.

In one such instance, in October 2020, three medical experts from three renowned universities decided the public discussion about lockdowns had become too one-sided.

The trio — which included Bhattacharya of Stanford, Sunetra Gupta of University of Oxford, and Martin Kulldorff of Harvard Medical School — crafted a short statement opposing the lockdowns, arguing that there was no scientific consensus for school closures and other stringent measures.

“Keeping [lockdown] measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed,” the trio warned in the statement, which was named the “Great Barrington Declaration,” after the town where it was written in the Berkshires.

Kulldorff said he was not prepared for the visceral response. Within days, he began receiving anonymous death threats via email and accusations that he supported mass murder. Facebook deleted a page set up by the scientists, and Kulldorff’s Twitter account was suspended.

Dr. Francis Collins, the former head of the National Institutes of Health, wrote an email at the time to Dr. Anthony Fauci, then director of the National Institute of Allergy and Infectious Diseases, in which he called for a “quick and devastating published take down” of its premises, according to emails obtained by the American Institute for Economic Research, a free market think tank.

Three years later, Collins said in a public forum that lockdowns caused widespread harm to public health and the Great Barrington Declaration could have been a “great opportunity” for a broad scientific debate about lockdowns. Collins, who recently retired from the NIH, declined to be interviewed.

Fauci did not respond to multiple interview requests.

To the dismay of some public health advocates, there has never been a public reckoning over the lockdown measures.

Robert Moffit, a senior research fellow at the conservative Heritage Foundation, said Congress should appoint a bipartisan commission with subpoena power that would investigate the extent of the harm caused and why alternative points of view were silenced.

“We need to know why all these federal health agencies failed to respond to the latest science on lockdowns,” Moffit asked.

Even some who supported the lockdown measures five years ago are now doubtful they were worth the long-term costs.

Nate Dube, 53, of Dorchester, was initially relieved that schools and businesses were closed. Dube has spinal muscular atrophy, a rare muscle-wasting disease, and is more susceptible to respiratory illnesses. He also lives a block away from a now-shuttered facility, Carney Hospital, that in May 2020 became the nation’s first hospital dedicated to treating COVID-19 patients.

Each day, ambulances carrying infected patients rushed by the window of his apartment in Dorchester.

He recalled being so paranoid about getting infected that he washed down his groceries and was afraid to open his mail.

But as the months of seclusion passed, he ached to see friends and began to miss the sounds of children playing outdoors.

“Early on the lockdowns felt like a lifesaver,” Dube said, “but then they just went on too long.”

Siddiqui, now a Cambridge city councilor, said a key lesson from the pandemic is that public leaders be honest about what they don’t know — and not create false hopes. “We can’t go on pretending like there wasn’t an impact from the lockdowns,” she said. “Even if it’s hard to reflect on it now.”

For an upcoming story to mark the anniversary, the Globe is asking readers to share their memories of moments from the pandemic. If you have any photos, videos, social media posts, or written recollections you’d like to share, please fill out the survey below.

Copyright Boston Globe Media Partners, LLC 2025

There are moments where life is divided into a before and an after. Something so significant occurs that it permanently alters the way you perceive the world and yourself in it.

For many of us, 11 March 2020 is one of those moments. That’s the day that the World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus declared COVID-19 a pandemic.

The stock market plunged, U.S. President Donald Trump banned travel from Europe, and the National Basketball Association (NBA) suspended its season until further notice.

At the same time, security practitioners were working around the clock to put in place measures to protect their employees and organizations. Ahead of the fifth anniversary of the pandemic declaration, Security Management spoke with a range of security and health professionals to understand how the COVID-19 pandemic experience shaped them and what it means for the future of risk management and emergency preparedness.

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COVID-19 put public health officials on the front lines against a once-in-a-lifetime threat. It's left them with less power and resources to respond to future emergencies.

Why it matters: Instead of strengthening America's public health infrastructure, the pandemic experience spawned hundreds of new laws in at least 24 states limiting public health orders or otherwise undercutting emergency responses.

Republicans in Congress have also called for funding cuts to the Centers for Disease Control and Prevention, and the Trump administration and Health and Human Services Secretary Robert F. Kennedy are pivoting to chronic diseases, nutrition and nontraditional cures.
What they're saying: Public health experts say it's all left the system weaker and less prepared for everyday threats — let alone the next big crisis.

"Imagine if we just had a major fire ripping through our city, and our first instinct once we finally put the flames out is to basically get rid of all of our fire departments," said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.
"That is essentially what we're seeing happen here."
The big picture: The weakening of public health is evident at every level, from small rural counties up to the highest ranks of the federal government, experts say.